Provider Demographics
NPI:1477846301
Name:GENEWICK, LORRAINE MARIE (LMT)
Entity Type:Individual
Prefix:
First Name:LORRAINE
Middle Name:MARIE
Last Name:GENEWICK
Suffix:
Gender:F
Credentials:LMT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7620 N HARTMAN LN
Mailing Address - Street 2:SUITE 184
Mailing Address - City:TUCSON
Mailing Address - State:AZ
Mailing Address - Zip Code:85743-8263
Mailing Address - Country:US
Mailing Address - Phone:520-572-1265
Mailing Address - Fax:
Practice Address - Street 1:7620 N HARTMAN LN
Practice Address - Street 2:SUITE 184
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85743-8263
Practice Address - Country:US
Practice Address - Phone:520-572-1265
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-05-25
Last Update Date:2011-05-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZMT-13782225700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage Therapist